Why Are My Periods So Heavy?

Jump to a section

• 0:02What a normal period is
• 1:09Causes of heavy bleeding
• 1:54Bleeding disorders
• 3:26Bleeding between periods
• 4:34Cancer and biopsies
• 6:48Final advice

Full transcript

1. 0:02What a normal period is

   Hi, I'm Dr. Taz Varkey. Today I'd like to do the last video on my series on periods. Specifically, I want to discuss heavy periods. What does it mean if your period is excessively heavy? To start the conversation, I'm going to remind you about what's normal. So a normal period occurs about every 21 to 35 days, so the average menstrual cycle is 28 days, but some women can be within 7 days shorter or 7 days longer.

2. 0:25

   And sometimes, by some definitions, even a 38 day cycle is considered normal. So this varies, and it depends on who you ask, but just think of it as plus or minus 7 days of a 28-day cycle.

3. 0:47

   And in terms of the duration, generally less than 7 days but more than 2 to 3 days is normal. And in terms of the amount, I'll leave that up to the patient, but if a patient, meaning it depends on if the patient herself thinks their periods are too heavy, that's important. But if a patient is soaking through a powdered tampon every two hours or less, that's excessive and is most likely going to lead to anemia or iron deficiency, and so we need to investigate that, especially if it bothers her.

4. 1:09Causes of heavy bleeding

   And what are the possible causes of such heavy bleeding? So one of the most common things is something called fibroids, and as in a few episodes ago or a few videos ago, I talked about fibroids and how they're benign growths of the uterine lining.

5. 1:31

   If those fibroids are pushing on the cavity, it can cause very heavy bleeding. There's a condition called adenomyosis, which is where the uterine lining grows backwards into the muscle of the uterus itself, and then every month when the uterine lining is getting thickened and it's about to come out in the form of a period, these areas that have grown into the muscle will also thicken and cause heavy, excessive bleeding.

6. 1:54Bleeding disorders

   If a teenager, a young woman, let's say her very first period is excessively heavy, that woman, we have to think about bleeding disorders. Could she have something in her that is causing her to not be able to clot blood properly, so therefore when she bleeds it just can't be controlled? These patients will often also have easy bruising or bleeding from their gums. So it's kind of a rule of thumb that if a young girl comes in and right from the get-go with her first period is having excessively heavy periods, the doctor should do tests to rule out bleeding disorders, and most pediatricians know this.

7. 2:39

   We used to think that thyroid irregularities could cause heavy bleeding, and I think that there are still some studies that support that theory, but it's not a common finding. I usually do check thyroid when people come in with bleeding irregularities, but it doesn't seem to be as common as we thought that it's responsible for heavy periods.

8. 3:03

   And then lastly, polyps. So polyps are benign growths in the actual uterine lining that, if present a large number or large polyp itself, can cause heavy periods. Now, as I say with everything else, this is not a comprehensive list, and this is just kind of some of the more common things. I just want to give you guys an idea of some of the different things that the doctor is thinking about and that you might want to ask about.

9. 3:26Bleeding between periods

   There's another type of abnormal bleeding that I want to cover today as well, which is not heavy periods but bleeding in between your periods. So where your periods are normal, but they're just there, you're bleeding on and off throughout the whole month, and that might just be for a few days in the middle of the month, it might be every single day of the month. What does that mean?

10. 3:48

    Well, there's a whole list of other things, some of which overlap with the ones I just discussed. So again, it could be due to fibroids as I just mentioned, or polyps, or a common one. So the polyp will get stimulated during the middle of the month and let a little bit of blood, so we generally, this tends to be more light spotting that occurs in between one period to another.

11. 4:12

    Birth control pills sometimes, just when you start new pills, that's a common side effect of spotting. It's not abnormal. Oftentimes if you're starting a new pill, if you just give it a few months, the spotting will go away, but if it doesn't, you can talk to your doctor, and they can sometimes just increase the estrogen dose or change the progesterone dosing and pick a different pill and make it go away.

12. 4:34Cancer and biopsies

    More seriously, cancer can be a cause actually of both of these. I didn't even mention that in the heavy period section, but if a woman over 45 has heavy bleeding, we automatically want to do a biopsy to rule out cancer, and that would be the same as if a woman over 45 has bleeding in between cycles. That's also something where we want to rule out precancer or cancer, and we do that with a biopsy.

13. 4:56

    Sometimes we'll do that for women that are younger than 45 if they have a strong family history of uterine cancer. So back to irregular spotting. Infections can cause that, so basically we look for things like chlamydia, gonorrhea, pelvic infections of the uterus that might cause the irregular bleeding. And any condition in general on the cervix can cause spotting.

14. 5:17

    So we would look at the cervix and see, does she have a polyp growing off the cervix instead of on the uterus but from the cervix that can actually cause spotting or bleeding in between periods? Or sometimes if a woman just has a sensitive cervix, there's a part of the cervix called the ectropion that, if it's very prominent in a young woman, then when she has sex or just depending on where she is in the cycle, she can get a little bit of bleeding from the surface of the cervix, and that's not necessarily abnormal but can be annoying.

15. 5:40

    And lastly, cervical cancer or precancer can present with bleeding in between periods. So we'd want to make sure that Pap smear is updated, and the doctor would be perhaps doing other tests to look for cervical precancer or cancer.

16. 6:03

    So again, this is just meant to be a broad outline of what can cause abnormal bleeding. Please, please do not walk away from this thinking that you have cancer if you have any kind of irregular bleeding. That's actually not the most common cause of bleeding, but it's the most serious one.

17. 6:26

    So the doctors are always going to think about that, and if they don't, you should ask about it. And you always want to think about pregnancy with any kind of abnormal, especially bleeding in between your periods. The first thing we're gonna ask you to do, or the doctor will do, is a pregnancy test, so make sure that's normal before you proceed on with asking about testing for all these other things.

18. 6:48Final advice

    So I hope this was helpful. This was by no means meant to be a comprehensive list, and this is not meant to be taken as medical advice for you in particular. If you have abnormal bleeding, you have to go in to talk to your doctor, because there's so much more we'd have to ask you personally to figure out your problem. But I hope this helps as a basic guideline.

19. 7:10

    Thanks for tuning in, and don't forget to subscribe.